HMA Weekly Roundup

Alabama

Alabama Seeks Medicaid Waiver to Cover Opioid, SUD Services for Individuals in IMDs. The Centers for Medicare & Medicaid Services announced on August 1, 2023, that Alabama is seeking a five-year Section 1115 Medicaid waiver to cover opioid and substance use disorder (SUD) treatment and recovery services for Medicaid beneficiaries in Institutions for Mental Diseases (IMDs). The waiver also proposes extending limited Medicaid coverage to eligible individuals who lack health insurance and meet the criteria for SUD. The federal public comment period runs from August 1, 2023 through August 31, 2023. Read More

Alaska

Alaska Medicaid to Cover Assisted Living Services in At-home Settings. KINY Radio reported on July 29, 2023, that Alaska Governor Mike Dunleavy signed Senate Bill 57, which authorizes the state’s Medicaid program to pay for assisted living services in at-home settings for elderly adults and adult foster children. Under the bill, the Alaska Department of Health will also license individuals to run adult care homes and set rules for operating the homes.

California

California Receives Approval to Lift the Medicaid Asset Test in 2024. Beckers Payer Issues reported on July 28, 2023, that the Centers for Medicare & Medicaid Services has approved a state plan amendment to eliminate asset tests for Medicaid eligibility in California, effective January 1, 2024. Read More

Florida

Florida Seeks Waiver to Pilot Managed Care Program for Individuals with Intellectual and Developmental Disabilities. The Florida Agency for Health Care Administration announced on July 28, 2023, that it is seeking a federal waiver to pilot comprehensive managed care coverage for certain individuals with intellectual and developmental disabilities. The voluntary program would serve up to 600 individuals and provide managed medical assistance (traditional Medicaid), long-term care waiver services, and Florida Developmental Disabilities Individual Budgeting (iBudget) waiver services. A 30-day public comment period runs through August 27, 2023. Read More

Florida Deficient in Documentation of Medications Prescribed to Foster Children, Audit Finds. The Capitolist reported on July 28, 2023, that Florida has improperly documented psychotropic and opioid medications prescribed to children in foster care, according to a federal audit that analyzed Medicaid claim records, case files, and health care records. The audit found that 36 out of 85 of children prescribed psychotropic medications and 57 out of 60 children prescribed opioid medications were not recorded in Florida’s Safe Families Network. The audit recommended medication management training and coordination with the Florida Agency for Health Care Administration to broaden access to Medicaid data and improve medication oversight. Read More

Illinois

Meridian Health Plan Names Cristal Gary as President, CEO. Meridian Health Plan of Illinois announced on July 31, 2023, that it has named Cristal Gary as president and chief executive, effective immediately. Cristal Gary has most recently served as the Chief Advocacy Officer for Ascension Illinois. Read More

Medica, OSF HealthCare to Introduce New Medicare Advantage Plan. OSF Healthcare announced on August 1, 2023, that it will introduce a new Medicare Advantage plan with MN-based health plan Medica this fall in central Illinois. The plans will be available during this fall’s Medicare annual enrollment period to residents in seven Illinois counties. Read More

Kentucky

Kentucky Republican Gubernatorial Nominee Supports Medicaid Work Requirements. The Associated Press reported on July 26, 2023, that Republican gubernatorial candidate Daniel Cameron would seek federal permission to institute Medicaid work requirements if elected. Under the plan, able-bodied adults would need to work, enroll in college, or be involved in job training or community service to receive Medicaid coverage. Read More

Louisiana

Louisiana Medicaid Enrollment Falls 3,000 in June. KTBS3 reported on July 26, 2023, that Louisiana Medicaid enrollment was 2.05 million in June, down 3,177 from a month earlier, marking the first month-over-month decline in the past year. Total enrollment in July 2022 was 1.98 million.

Michigan

Michigan Extends Deadline for Submitting Medicaid Renewal Paperwork by Month. The Michigan Department of Health and Human Services announced on July 26, 2023, that it has extended the deadline for Medicaid beneficiaries to submit eligibility renewal paperwork by a month through May 2024. The state had originally given beneficiaries with paperwork due in June until July 31. Now all beneficiaries will have an extra month past their original due date. Read More

Minnesota

Minnesota Disenrolls 6,867 Medicaid Beneficiaries During June Redeterminations. The Minnesota Department of Human Services announced on July 10, 2023, the disenrollment of 6,867 Medicaid beneficiaries during June redeterminations. The state renewed coverage for nearly 47,200 beneficiaries.

Missouri

Missouri Disenrolls 32,000 Medicaid Beneficiaries During June Redeterminations. The Missouri Independent reported on July 27, 2023, that Missouri disenrolled more than 32,000 Medicaid beneficiaries during June redeterminations. Around half were children, with most losing coverage for procedural reasons. Out of the 116,000 beneficiaries up for review, the state renewed coverage for 43 percent. Reviews are pending for another 29 percent. Read More

New Hampshire

New Hampshire Disenrolls Approximately 39,500 Medicaid Enrollees, Launches Outreach Pilot. Seacoastonline reported on July 28, 2023, that New Hampshire has disenrolled approximately 39,500 Medicaid beneficiaries as of June out of 77,200 eligibility redeterminations conducted. Nearly 17,420 failed to apply for renewal, and the state has launched a pilot project in collaboration with the federal government to expand outreach to this population. Read More

North Carolina

North Carolina Reaches Agreement with CMS in Hopes of Launching Medicaid Expansion by October 1. The North Carolina Department of Health and Human Services announced on July 26, 2023, an agreement with federal regulators in hopes of implementing Medicaid expansion on October 1 once state lawmakers pass a budget. The agreement with the Centers for Medicare & Medicaid Services (CMS) will allow the state to proceed with required public notices. The state is also working to shorten the implementation timeline to 30 days from an originally expected 90 to 120 days. The state cannot implement expansion without a budget or unless legislators decouple expansion from the budget. Read More

Oregon

Oregon Calls for Medicaid CCOs to Outline Plan for Investing Excess Profits in Community. The Portland Business Journal reported on July 26, 2023, that the Oregon Health Authority is calling on the state’s 16 Medicaid Care Coordination Organizations (CCOs) to detail plans for reinvesting higher than expected 2022 profits back into the community. Governor Tina Kotek has asked for a “significant” investment by CCOs, equivalent to between 1.5 percent and two percent of revenues, especially to support housing and behavioral health measures. Read More

Medicaid Needs to Improve Access to Mental Health, SUD Residential Treatment, Report Finds. The Oregon Capital Chronicle reported on July 31, 2023, that Oregon needs to improve access to residential treatment for mental health and substance use disorder, according to an annual ombuds report. The report found that individuals are turned away due to a lack of beds or a lack of providers accepting Medicaid patients. The Oregon Health Authority stated that they will address the gaps found in the report through a statewide assessment of residential mental health and addiction care options and a reevaluation of current rules and processes. Read More

Texas

Texas Receives CMS Approval to Continue State Directed Payment Programs. The Texas Health and Human Services Commission announced on July 31, 2023, that the Centers for Medicare & Medicaid Services (CMS) approved the continuation of the state directed payment programs for fiscal 2024. The five programs (Comprehensive Hospital Increase Reimbursement Program, Quality Incentive Payment Program, Texas Incentives for Physicians and Professional Services, Directed Payment Program for Behavioral Health Services, and Rural Access to Primary and Preventive Services Program) comprise around $8.5 billion in Medicaid payments for hospitals, nursing facilities, physician groups, behavioral health, and primary care. Read More

Virginia

Virginia Medicaid Managed Care RFP Release Delayed to Mid to Late August. The Virginia Department of Medical Assistance Services announced that the state’s Medicaid managed care request for proposals (RFP) will be released mid to late August, with an estimated issue date of August 18. Read More

Senator Pushes for Prescription Drug Affordability Board. NBC 29 reported on August 1, 2023, that Virginia Senator Bill Stanley (R-Moneta) is advocating for the establishment of a Prescription Drug Affordability Board to set limits on how much individuals would pay for prescription drugs. Read More

National

CMS Releases Final Medicare Inpatient, Long Term Care Prospective Payment System Rule. The Centers for Medicare & Medicaid Services (CMS) released on August 1, 2023, the final fiscal 2024 Medicare prospective payment system rule for inpatient and long-term care hospitals. The rule includes a 3.1 percent increase in Medicare inpatient payment rates for hospitals that participate in the inpatient quality reporting program. Under the long-term care hospital prospective payment system, CMS expects rates to increase by 0.2 percent. The rule also includes a health equity adjustment in the scoring methodology for the hospital value-based purchasing program that rewards hospitals that serve higher proportions of dual-eligible patients and includes a policy to recognize higher costs that hospitals incur when treating people experiencing homelessness when hospitals report social determinants of health codes on claims. Read More

CMS Increases Medicare Reimbursement Rates for Skilled Nursing Facilities by 4 Percent in Fiscal 2024. Modern Healthcare reported on July 31, 2023, that the Centers for Medicare & Medicaid Services (CMS) released a final rule to increase Medicare reimbursement rates by 4 percent for skilled nursing facilities (SNFs) in fiscal 2024. The final rule includes updates to the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program and finalizes a constructive waiver process to relieve administrative burdens for CMS related to processing Civil Monetary Penalty appeals. Read More

CMS Projects 1.8 Percent Decrease in Medicare Part D Premiums in 2024. The Centers for Medicare & Medicaid Services (CMS) announced on July 31, 2023, the projected average total monthly premium for Medicare Part D coverage to be about $55.50 in 2024, a decrease of 1.8 percent from 2023. CMS anticipates releasing the premium and cost-sharing information for 2024 Medicare Advantage and Part D plans in September. Read More

U.S. Lawmakers Introduce Bill to Support Individuals with Severe Mental Illness. Spectrum News reported on August 1, 2023, that U.S. Senator Kirsten Gillibrand (D-NY) and Representative Dan Goldman (D-NY) introduced the Strengthening Medicaid for Serious Mental Illness (SMI) Act to support individuals with SMI. The bill would create a new package of Medicaid services for individuals with SMI, set a national standard for SMI care, and incentivize states to provide intensive community-based services to treat SMI. Read More

Nearly Half of Dual Eligibles Receive Medicare Services Through Medicare Advantage Plans. KFF reported on July 31, 2023, that 51 percent of dual eligibles received Medicare services through traditional Medicare in 2020, while the remaining 49 percent received care via Medicare Advantage (MA) plans. MA includes 24 percent in coordination-only dual eligible special needs plans (D-SNPs), 17 percent in individual MA plans, 3 percent in dual demonstration plans, 3 percent in fully integrated dual eligible SNPs, 2 percent in other SNPs, and 0.4 percent in Program of All-Inclusive Care for the Elderly. MA enrollment rates were higher among beneficiaries who were age 65 and older than those under age 65. Read More

CMS Announces Alternate Payment Model for Dementia Care Services, Resources for Caregivers. The Centers for Medicare & Medicaid Services (CMS) announced on July 31, 2023, the Guiding an Improved Dementia Experience (GUIDE) Model, a voluntary, nationwide program which will test an alternate payment model for key supportive services to individuals with dementia, including comprehensive, person-centered assessments and care plans and care coordination. Individuals with dementia and their caregivers will have access to a care navigator who will help them access services and supports. Applications for the eight-year model will be released in fall 2023. Letters of intent are due September 15, 2023, and implementation will begin July 1, 2024. Read More

Medicaid, CHIP Enrollment Is Nearly 94.2 Million in April 2023. The Centers for Medicare & Medicaid Services (CMS) announced on July 31, 2023, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was nearly 94.2 million in April 2023, an increase of 274,934 from March 2023. Medicare enrollment was approximately 65.8 million, up 88,441 from March 2023, including 31.9 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs. Read More

CMS Increases Medicare Hospice Rates by 3.1 Percent in Fiscal 2024. Modern Healthcare reported on July 28, 2023, that Medicare hospice rates will increase 3.1 percent in fiscal year 2024, under a final rule issued by the Centers for Medicare & Medicaid Services. A draft rule proposed in March previously stated the increase would be 2.8 percent. Additionally, hospice providers that fail to meet quality reporting requirements will be subject to a four-percentage-point penalty, beginning in 2024. Read More

Medicaid Disenrollments Near 4 Million Following Redeterminations. The Associated Press reported on July 28, 2023, that nearly 4 million people have been disenrolled from Medicaid following eligibility redeterminations. A federal report found that of the 715,000 beneficiaries that lost coverage during April Medicaid eligibility redeterminations, four in five were for procedural reasons. Health and Human Services Secretary Xavier Becerra sent a letter to all governors calling for implementation of strategies to avoid Medicaid disenrollment due to procedural reasons. Read More

CMS Is Urged to Settle Discrepancy Between Proposed Prior Authorization Data Rules. Modern Healthcare reported on July 27, 2023, that hospitals, physicians, and insurers are urging federal regulators to reconcile two sets of proposed standards concerning the use of electronic data exchange when processing prior authorizations. The proposals would have health insurers and providers complying with one set of standards, while government-sponsored insurers would comply with another. The American Hospital Association, American Medical Association, health insurance group AHIP, and Blue Cross Blue Shield Association communicated their concerns to the Centers for Medicare & Medicaid Services (CMS). Read More

Justice Reportedly Begins Antitrust Investigation Into Managed Care Industry. Health Payer Specialist reported on July 26, 2023, that U.S. Department of Justice has reportedly opened an antitrust investigation into the managed care industry. Capitol Forum, which first broke the story, did not name specific health plans under investigation. Read More

House, Senate Committees Advance PBM Oversight Bills. Modern Healthcare reported on July 26, 2023, that the Senate Finance Committee and the House Ways and Means Committee have both advanced bills aimed at increasing oversight of pharmacy benefit managers (PBMs). The Senate bill bans spread pricing in Medicaid and prohibits PBMs from including outside fees and rebates into Medicare drug pricing. The House bill requires PBMs to calculate Medicare drug cost sharing for beneficiaries using negotiated rates or discounted cash price (whichever is cheaper), rather than manufacturers’ sticker prices. Read More

Seven Million Women Lack Maternal Care Access, Report Finds. USA Today reported on August 2, 2023, that nearly seven million women live in maternity care deserts, or U.S. counties without obstetric facilities or providers, according to a 2022 report released Tuesday by nonprofit organization March of Dimes. The number of maternity care deserts has increased by two percent since their 2020 report. In the 2022 report, approximately 36 percent of U.S. counties were designated as maternity care deserts, of which 61 percent were in rural communities. Read More